No date yet for full e-records exchange between VA, Defense

By Bob Brewin

May 8, 2007

Neither the Defense nor the Veterans Affairs departments have set a date for deploying modernized electronic health record systems that would ensure seamless data interchange between the two agencies, a Government Accountability Office official said Tuesday.

Valerie Melvin, GAO's director of human capital management, told a House Veterans Affairs subcommittee that the Pentagon had originally projected that it would finish deployment of its Armed Forces Health Longitudinal Technology Application, which is designed to contain outpatient records, and its Clinical Data Repository - holding information on more than 9 million active duty and retired military personnel -- by 2011.

The VA, she said, had estimated it would deploy its Health eVet records system, which is intended to replace its existing Veterans Health Information Systems and Technology Architecture system, by 2012. But, she said, officials at both departments "told us there is currently no completion date for either system."

The two departments have made some progress in short-term projects to share health information, but Melvin said "these exchanges are as yet limited, and significant work needs to be done to expand the data shared and integrate the various initiatives."

Exchange of information between Defense and the VA on troops severely wounded in combat in Afghanistan and Iraq is frustrated by the Pentagon's paper-based records system, Melvin said. Soldiers wounded in combat are first evacuated to the Landstuhl Regional Medical Center in Germany, where inpatient records (except discharge summaries) are paper-based.

Defense hospitals that later receive wounded patients, such as Walter Reed Army Medical Center and the National Naval Medical Center in Bethesda, have an inpatient electronic records system called the Clinical Information System. But only a limited number of clinicians at three VA polytrauma centers -- in Tampa, Fla.; Richmond, Va.; and Palo Alto, Calif. -- have electronic access to that system, Melvin said. Such centers serve soldiers with severe injuries to more than one organ system.

When patients are transferred from Walter Reed to those polytrauma centers, staff at Walter Reed have to print records from the Clinical Information System, scan the paper and transmit the scanned data to the VA. Defense staff told GAO that this labor-intensive process is feasible only because of the small number of records of polytrauma patients involved in the process -- about 350 to date.

Access to radiological images is a high priority for polytrauma doctors, but Melvin said transmitting these images from Walter Reed or the Bethesda Naval Medical Center requires manual intervention when each image is received by the VA.

The Pentagon and the VA have made some progress in sharing electronic patient information, she said, through a project known as the Bidirectional Health Information Exchange, which allows text-only viewing of certain data.

Dr. Gerald M. Cross, acting principal deputy undersecretary for health at the VA, told the subcommittee that the department has installed BHIE at every one of the VA's 154 hospitals and more than 800 clinics. He said Defense has installed the system at 18 hospitals and more than 190 outpatient clinics, and by June of this year expects it to be up and running at all of its facilities.

Melvin said that the VA and Defense also have successfully fielded the Laboratory Data Sharing Interface, allowing the two departments to share lab test data.

Stephen Jones, assistant Defense secretary for health affairs, told the subcommittee that to date, his department has electronically transferred medical records on 3.8 million patients to the VA. Both departments, he said, have started work to develop a joint inpatient electronic health records system. They expect to identify the requirements for the project by the spring of 2008.